OP0178-HPR YOU FIRST: A COST-EFFECTIVE NURSE-LED PATIENT SUPPORT PROGRAMME – RETROSPECTIVE ANALYSIS FROM A LARGE MULTI-ETHNIC SETTING
Authors: M. Nisar, J. Begum
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The global impact of COVID-19 on elective rheumatology services is unprecedented, <sup>[1,2]</sup> and the number of people on waiting lists for consultant-led elective care in the UK has almost doubled. <sup>[3]</sup> Implementation of patient support programmes that provide an individualised nurse-led service, such as You First, may help to reduce the strain on healthcare resources. You First is aimed at people who have been prescribed secukinumab, an injectable anti-interleukin 17A monoclonal antibody, for approved indications including psoriatic arthritis (PsA), ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis. <h3>Objectives</h3> This retrospective analysis aimed to evaluate the benefits of the You First patient support programme on the Rheumatology service at a large university teaching hospital with a catchment population of 350,000, of whom 40% are from ethnic minorities. <h3>Methods</h3> The analysis included adult participants who were eligible for treatment with secukinumab according to National Institute for Health and Care Excellence criteria and were enrolled in the You First programme. All You First nurses were registered with the Nursing, and Midwifery Council and underwent specific training, competency assessment and validation to ensure they met all regulatory clinical standards of National Health service (NHS) practice. Each participant was assigned to a dedicated nurse who visited the participant's home to provide routine clinical assessments, routine follow-up visits, phlebotomy service, psychological support visits, injection training and routine secukinumab administration, as required. Participants could also schedule regular nurse telephone calls to discuss any disease or drug related concerns such as secukinumab dosing/adherence check and side effect management. All data gathered during the home visits and telephone calls were reported to the treating physicians. Calculation of cost savings was based on the number of visits carried out as part of You First and the cost that the NHS would have incurred if the visit occurred at the hospital (£2.02 for phlebotomy service, £24 for telephone contact, and £99 for each assessment, routine follow-up visits and psychological support visit). Here we present annualised data from 28 February 2019 to 14 July 2022. <h3>Results</h3> In total, 126 participants with PsA (n=81) and AS (n=45) were observed for 17.2 months on average. At baseline, the mean age was 52.7 years and 39.2% of participants were male. During the timeframe of this analysis, You First nurses had 1160 contact points with the clinical team (793 visits; 367 telephone calls). The median (interquartile range) number of visits and telephone calls carried out as part of the programme per participant per year was 6.4 (4.6–11.3): phlebotomy service 0.4 (0.0–1.6), clinical assessments 1.4 (0.0–2.0), routine follow-up visit 1.6 (0.7–3.1), psychological support visit 0.0 (0.0–0.0) and telephone contact 2.0 (1.0–4.7). This translated to an annual cost saving of £64,156.49 (phlebotomy service £335.90, clinical assessments £15,159.13, routine follow-up visits £36,434.58, psychological support visit £368.90, telephone contact £11,857.99). <h3>Conclusion</h3> Implementation of You First at this large university teaching hospital yielded substantial cost savings for the NHS, with outsourced visits providing the most cost savings. You First allowed people with PsA or AS to be managed at home, freeing NHS capacity for appointments with new and complex patients in the clinic. <h3>References</h3> [1]Akintayo RO, et al. Rheumatology (Oxford) 2021;60:392-398 [2]Machado PM, et al. Rheumatology Advances in Practice 2023;7:rkac108 [3]BMA. NHS backlog data analysis. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis Accessed 6th January 2023. <h3>Acknowledgements</h3> Medical writing support was provided by Anna Wydra, MSc, of OPEN Health Communications (London, UK) and funded by Novartis. <h3>Disclosure of Interests</h3> Muhammad Nisar Speakers bureau: MKN has received speaker fees from Novartis, Grant/research support from: MKN has received educational grants from Novartis, Julie Begum Speakers bureau: JB has received speaker fees from Novartis, Grant/research support from: JB has received educational grants from Novartis.